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GI 3 Flashcards

1
Q

Patients with achalasia are at increased risk of what

A

Esophageal cancer (usually SCC) (stasis and fermentation cause mucosal inflammation, epithelial hyperplasia and dysplasia)

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2
Q

Splenic vein thrombosis clinical features

A

history of chronic pancreatitis (splenic vein runs along posterior surface of pancreas so chronic inflammation can lead to thrombosis) + *isolated gastric varices (near gastric fundus only, never esophageal varices)
- variceal hemorrhage + epigastric pain

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3
Q

Management of splenic vein thrombosis

A

splenectomy

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4
Q

what is non-ulcer dyspepsia?

A

Functional dyspepsia (diagnosis of exclusion)

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5
Q

Next step after cirrhotic with mass on US + elevated AFP

A

IF less than 1 cm – repeat US in 3 months
IF greater than 1 cm – MRI liver with contrast (better sensitivity and specificity than CT for differentiating malignant nodule from regenerative nodules)

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6
Q

Management of diarrhea after ileal resection

A

cholestyramine (ileal resection leads to bile salt malabsorption and thus can’t absorb fats or fat-soluble vitamins. cholestyramine binds to bile acids)

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7
Q

Initial management of non-GERD-sounding dyspepsia (without alarm features)

A

IF under ago 60 + NO compelling indication for EGD – h pylori testing
IF over 60 or compelling indication for EGD –> EGD

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8
Q

Boerhaave syndrome clinical features + imaging

A
  • hx of vomiting + chest pain + often rapid development of pleural effusion
  • subcutaneous emphysema + mediastinal air (described as “retrocardiac air shadow”)
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9
Q

Chronic diarrhea in patient with systemic sclerosis

A

SIBO (due to reduced peristalsis and intestinal dilation)

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10
Q

antibiotic for SIBO

A

rifaximin

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11
Q

Multiple stomach ulcers OR thickened gastric folds think

A

gastrinoma (zollinger-ellison syndrome)

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12
Q

gastrinoma (zollinger-ellison syndrome) diagnosis

A

serum gastrin level

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13
Q

PBC is

A

primary biliary cholangitis

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14
Q

sequela of PBC

A
  • Metabolic bone disease (osteoporosis and/or osteomalacia)
  • hepatocellular carcinoma
  • malabsorption, fat-soluble vitamin deficiencies
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15
Q

Additional management of PBC

A

calcium and vitamin D supplementation

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16
Q

Initial step in hemodynamically unstable GI bleed

A

NOT PRBC transfusion (as per MKSAP) if Hgb WNL

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17
Q

initial steps in management of variceal bleed

A
  • volume resuscitation
  • IV octreotide
  • abx (7 day course of prophylactic abx, even if cultures remain negative)
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18
Q

Management of IDA if initial c-scope and EGD are negative

A
  • small bowel evaluation with capsule endoscopy
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19
Q

Appearance of biopsy in microscopic colitis

A
  • mononuclear lymphocytic infiltrates (high levels of intraepithelial lymphocytes)
  • abnormally thickened sub epithelial collagen band
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20
Q

other clinical features of microscopic colitis

A
  • fecal urgency and incontinence
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21
Q

Pancreatic pseudocyst clinical features

A
  • develop after pancreatitis episode commonly

- persistently elevated lipase after pancreatitis episode + abdominal fullness OR early satiety

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22
Q

Management of pancreatic pseudocysts

A
  • nothing (most pseudocysts resolve spontaneously)
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23
Q

IBS features

A
  • recurrent abdominal pain

- diarrhea alternating with constipation

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24
Q

First step in workup of IBS

A

rule out red flags (Bleeding, nocturnal symptoms or worsening abdominal pain, weight loss, abnormal labs)

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25
Q

Management of patient following up after an episode of diverticulitis

A
  • colonoscopy (rule out malignancy AND assess severity of diverticulitis)
  • indicated even if c-scope within the last 10 years
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26
Q

General pressure ulcer management

A

1) Nutritional support
2) Pressure relief measures (scheduled turning)
3) Rule out infection

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27
Q

Dressing for pressure ulcers

A 
Stage 1 (intact skin, just localized redness) -- transparent film dressing
Stage 2 (shallow, open ulcer) -- occlusive or semipermeable dressing (maintain moist wound environment)
Stage 3 (full thickness skin loss) -- hydrocolloid (NO OCCLUSIVE IF FULL THICKNESS)
Stage 4 (exposed bone, tendon, or muscle) -- wound closure
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28
Q

Management of Schatzki ring

A
  • dilation + *acid suppression therapy
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29
Q

Most frequent complication of schatzki ring

A

recurrence (frequently reoccur)

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30
Q

Syndrome for hepatic vein thrombosis

A

Budd-Chiari

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31
Q

Acute Budd-Chiari clinical features

A
  • young woman with *rapid onset abdominal pain + ascites + some underlying hyper coagulable disorder or trigger (HCC, OCP use, pregnancy)
32
Q

Diagnosis of boerhaave syndrome

A
  • CT or esophagography with gastrografin (similar to barium swallow but gastrografin is used)
33
Q

Infected pancreatic necrosis management

A

CT-guided aspiration OR empiric abx (carbapenem)

IF no response to antibiotics – surgery

34
Q

antibiotics for treatment of infected pancreatic necrosis

A

carbapenem or quinolone + metronidazole (anaerobe coverage and superior penetration into pancreatic tissue)

35
Q

SAAG cutoffs

A
  1. 1 (portal HTN)

2. 5 (heart failure vs. cirrhosis)

36
Q

treatment of chronic mesenteric ischemia

A
  • surgery or stenting
37
Q

acute mesenteric ischemia clinical presentation

A
  • rapid onset periumbilical pain
38
Q

treatment of acute mesenteric ischemia

A
  • broad spectrum abx
  • NG tube decompression
  • surgery for infarction or perforation
39
Q

Other PBC features

A
  • significant fatigue + pruritus
  • skin hyperpigmentation
  • can have inflammatory arthritis
40
Q

hemochromatosis vs PBC in terms of labs

A 
hemochromatosis = hepatocellular injury pattern
PBC = primarily cholestatic liver injury pattern
41
Q

Alarm features of GERD that required EGD prior to PPI trial

A
  • age over 50
  • dysphagia
  • weight loss
  • anemia
  • hematemesis, melena
  • failure of PPI trial after a month
  • not lack of response to OTC antacids
42
Q

Initial evaluation of cirrhosis

A

EGD (initial varices screening)

43
Q

Indications for SBP prophylaxis

A

1) prior episode of SBP
2) GI bleed
3) ascitic protein less than **1.5 if also impaired renal function or liver failure
4) Child-Pugh class C with bilirubin (greater than 3)

44
Q

Age cutoff requiring EGD prior to h pylori testing

A

Over age 60 need EGD

45
Q

other lab features of autoimmune hepatitis

A
  • multiple circulating autoantibodies (ANA, anti smooth muscle, may have antimitochrondial in low titer, anti liver-kidney microsomal-1 antibody)
46
Q

presentation of acute hep b

A
  • serum sickness like syndrome (fever, poly arthritis, *urticaial skin lesions)
  • can also present with fulminant liver failure
47
Q

ischemic colitis clinical features

A
  • abrupt onset abdominal pain followed quickly by hematochezia
  • commonly in watershed areas (splenic flexure, rectosigmoid colon)
48
Q

ischemic colitis vs. small bowel mesenteric ischemia

A
  • mesenteric ischemia = typically AF severe pain without significant abdominal tenderness, hematochezia is a late complication
  • ischemic colitis = early hematochezia
49
Q

Initial evaluation of suspected ischemic colitis

A

CT with contrast, followed by colonoscopy

50
Q

Definition + management of atypical + persistent anal fissures

A
  • atypical = lateral or anterior, multiple, painless, very deep, recurrent, non healing, no improvement with treatment
  • c-scope for evaluation of Crohn disease
51
Q

presentation of external hemorrhoids

A

IF thrombosed – pain

IF nonthrombosed – typically painless

52
Q

alcoholic hepatitis presentation

A

*fever
abdominal distension
other features I know about

53
Q

Meds causing medication-induced esophagitis

A
  • NSAIDS
  • tetracyclines
  • bisphosphonates
  • iron supplements
  • potassium chloride
54
Q

Management of medication-induced esophagitis

A
  • stop offending medication

- no need for EGD unless severe, atypical or persistent symptoms after 1 week)

55
Q

postexposure prophylaxis for hep A

A
  • vaccinate all household contacts (vaccine is more available than immune globulin and is easier to administer)
  • immune globulin in children under age 1 and immunocompromised individuals
56
Q

abdominal pain following colonoscopy think

A
  • perforation at polypectomy site

* may also have fever OR chest OR scapular pain

57
Q

Initial management of suspected abdominal perforation from colonoscopy

A
  • STAT abdominal x-ray plain and upright

- IF negative but high clinical suspicion – CT with contrast

58
Q

Acute hep B management

A
  • supportive care (most adult patients will improve clinically and cldar the infection)
59
Q

Presentation of proximal small-bowel obstruction

A
  • vomiting

- *have less abdominal distension

60
Q

Alternative causes of elevated lipase

A
  • CKD
  • DKA
  • intestinal obstruction or ileus
61
Q

Initial workup of SBO

A
  • plain upright CXR + upright and supine abdominal films
62
Q

Management of rectovaginal fistulas in IBD patients

A

IF asymptomatic – no treatment (most will heal spontaneously)

  • prolonged antibiotics + anti-TNF inhibitors
  • IF failed medical therapy: surgery
63
Q

Modified triple therapy for patient with pencillin allergy

A

flagyl instead of amoxicillin

64
Q

management of moderate to severe hypertriglyceridemia-induced pancreatitis

A

IF blood glucose is over 500 – start insulin drip to correct triglyceride levels
If glucose below 500 or severe pancreatitis – therapeutic plasma exchange apheresis

65
Q

next step in patient with celiac features and positive serology

A

Endoscopy with biopsy to establish diagnosis OR cutaneous biopsy with dermatitis herpetiformis

66
Q

next step in patient with celiac features and negative serology

A

IgA level

67
Q

healthcare maintenance for celiac

A
  • pneumococcal vaccination (associated with hyposplenism)

- screen for nutritional deficiencies and bone loss

68
Q

cause of respiratory alkalosis in cirrhotics

A
  • Increased minute ventilation (cause of which is unclear)
69
Q

Next step after patient with h pylori is found to have a peptic ulcer

A
  • obtain multiple biopsies ulcer to rule out malignancy (Peptic ulcer disease is strongly associated with gastric cancer and gastric MALT lymphoma)
70
Q

features of lactose intolerance

A
  • abdominal pain + bloating + flatulence

- secondary lactose intolerance can develop after acute infection or inflammation (destruction of lactase enzyme)

71
Q

Evaluation of PUD for H pylori

A

*Even if negative biopsy, stilll need a second test (urea breath or stool antigen) after patient has stopped PPI for 1-2 weeks (significant false negatives due to bleeding, PPI, or abx)

72
Q

When repeat endoscopy is indicated following diagnosis of PUD

A

*bleeding gastric ulcers

73
Q

Eosinophilic esophagitis clinical features

A

young man + atopy + intermittent solid-food dysphagia

- commonly food bolus

74
Q

Endoscopy in eosinophilic esophagitis

A
  • furrows, concentric rings, eosinophilic microabscesses (whitish papules and exudates)
75
Q

Treatment of eosinophilic esophagitis

A
  • dietary modification

- topical steroids

76
Q

Initial step in work up of suspected PSC

A

colonoscopy to rule out underlying IBD + colorectal cancer (significantly elevated risk)

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